fortifying the front line: the marcus collaborative coaching project sally fuhrmeister, m.s.,...

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Fortifying the Front Line: The Marcus Collaborative

Coaching Project

Sally Fuhrmeister, M.S., CCC-SLPSonja Ziegler, M.S., Dipl.- Psych.

Learning Objectives:

• The participant will be able to identify early red flags for autism in the early childcare setting.

• The participant will learn universal strategies for promoting active engagement in the early childcare setting.

• The participant will learn evidence-based components of successful adult learning and collaboration.

• The participant will be given an account of collaborative coaching in action.

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WHAT IS AUTISM???

DSM-5: Autism Spectrum Disorder

Delays and deviance in the development of social communication skills, with the

presence of restricted interests and/or repetitive behaviors, present in the early

developmental period.

4Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta ©2006 Children’s Healthcare of Atlanta, Inc. All rights reserved

Infants At-Risk for Autism/ASD

•Lack of, or attenuated joint attention skills•Less interest in interactive games•Less imitation•Infrequency in looking at objects held by others•Aversion to touch•Decreased flexibility in play•Decreased variety of toy choices & play themes•Less appropriate play with objects•Atypical patterns of social orienting•Lower frequency of looking at others•Contentedness when alone•Poor response to name•Reduced verbalizations/cooing•Reduced use of gestures •Disrupted affect regulation•Less affection toward familiar people &/or Increased negative affect•Reduced affective expressions


Toddlers At-Risk for Autism/ASDAbnormalities in social relatedness…

• abnormal eye contact• limited social smile• limited interest in other children• poor response to name

Limited competence with social communication…• difficulty understanding communicative gestures from

others • difficulty using gestures• decreased desire to share interests through pointing, giving

and showing• the child may use others as a “tool”• A low frequency of verbal or nonverbal communication• Atypical affect regulation such as limited sharing of affect or

a range of facial expression• Unusual vocalizations, body movements and sensory

behaviors• Limited functional play, an absence of pretend play and

repetitive interests/play

Overview of RED FLAGSSocial Interaction:• Lack of response to name by 12 months • Lack of appropriate eye gaze• Lack of sharing interest or enjoyment• Lack of warm, joyful expressions• Difficult to elicit a social smileCommunication: & Language• Lack of showing gestures or meaningful gestures by 12 months• Lack of pretend play by 18 months• Lack of coordination of nonverbal

communication• Unusual prosody (little variation in

pitch, odd intonation, irregular rhythm, unusual voice quality)

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Repetitive Behaviors & Restricted Interests:

• Repetitive movements with objects

• Repetitive movements or posturing of body, arms, hands, or fingers

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Prelinguistic CommunicationTypical Development Early Red Flags in Autism

Eye gaze, gaze shifting Gaze aversion

Response to name Lack of response to name

Orientation to speech Limited response to adult speech

Pointing Lack of pointing

Affect sharing Object focused

Caregiver referencing Lack of/limited caregiver referencing

Imitation Lack of imitation

Joint attention, response and initiation

Lack of/limited skills across these areas

Symbolic play Lack of symbolic play after 18 monthsLooking beyond typical speech milestones, there is a basis for social

communication before words come along!

8Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2012 Children’s Healthcare of Atlanta Inc. All rights reserved.

1 in 68For every 68 children born in the US, one of them has Autism

1 in 42 boys, 1 in 189 girls

Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta ©2006 Children’s Healthcare of Atlanta, Inc. All rights reserved

Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.

Autism Compared to Other Common Pediatric

Diseases/Conditions

Disease/Condition Prevalence Rate

Autism Spectrum Disorders 1:68

Congenital Heart Defects 1:125

Childhood Cancer (all types) 1:330

Juvenile Diabetes 1:500

Cystic Fibrosis 1:5,000

Muscular Dystrophy 1:20,000

Risk Factors of Autism Spectrum Disorders

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•ASDs are reported to occur in all racial, ethnic, and socioeconomic groups

•Brain disorder of genetic origins: the risk of an ASD for subsequent siblings of children with ASD is 20%

• The median age of diagnosis is 5 years.

• The median age of diagnosis is higher in underprivileged populations.

• CDC 2012: Largest increases in prevalence among Hispanic children (110%) and black children (91%) since 2009 CDC report

Missed opportunity for attenuating or maybe even preventing autism

Screening for Autism Spectrum Disorders

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• American Academy of Pediatrics:

screening at 18 and 24 months

• Studies have shown that 1/3 to 1/2 of

parents of children with ASDs notice a

developmental problem before their

child's first birthday.

• 80% of parents express concerns by 24

months of age

http://www.cdc.gov/ncbddd/autism/data.html

Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta ©2006 Children’s Healthcare of Atlanta, Inc. All rights reserved



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Challenges of Autism Spectrum Disorders

Intervention has the greatest impact on autism if…. it begins before 3 years of age

80% of children who need early intervention are missed.

(CDC, 2009; Filipek, Accardo, Baranek et al., 1999; NRC, 2001; USDOE, 2011)

Screening and Detection


Success at early screening and detection depends on “front-line” providers

and caregivers

CAREGIVERS

EARLY PROVIDERS

The National Research Council (2001) recommends that children

with ASD should be actively engaged in activities and

interactions for at least 25 hours per week.

How do we achieve that in the childcare

setting?

Everyday Activities

Supports

• Environmental supports• Sufficient and developmentally-appropriate

materials• Defined play centers• Balanced schedule (large and small group)• Structured transitions• Individualized support for children when needed• Engaging and motivating activities• Clear directions

Hemmeter, Otrosky, & Fox (2006)

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Child Behaviors

ACTIVE ENGAGEMENT

1. Emotional Regulation

2. Productivity

3. Social Connectedness

4. Gaze to Face

5. Response to Verbal Bids

6. Directed Communication

7. Flexibility

8. Generative Ideas

Caregiver Behaviors

TRANSACTIONAL SUPPORTS

1. Participation & Role

2. Make Activity Predictable

3. Follow Child’s Attention

4. Promote Initiations

5. Balance of Turns

6. Support Comprehension

7. Modeling

8. Expectations & Demands

Supports

Adapted from Autism NavigatorTM (Wetherby, Woods, Holland & Morgan, 2012)

Adult Learning and Collaboration

• Dunst and Trivette (2011) meta-analysis study:• Active-learner participation• Largest effect sizes found were related to the use of

evaluation strategies i.e. thinking about impact of new knowledge, reflection (engaging in self-assessment about the application of their knowledge and practice)

• Multiple adult-learning strategies result in the greatest effect sizes.

• Offer information, have multiple opportunities to practice and opportunities to evaluate and reflect on their use of strategies.

Coaching

Coaching is a method of transferring skills and expertise from a more experienced and knowledgeable practitioner to a less experienced one.

Coaching

• Several studies (Hemmeter, Snyder, Kinder, & Artman, 2010; Salisbury et al., 2010) have shown challenge of implementing coaching.

• Need for clear understanding of what coaching is.

• We have moved from one-day workshops and trainings in the realm of professional development, but work still needs to be done on effective frameworks (Synder, Hemmeter, & McLaughlin, 2011).

Key Components of Professional Development

(NPDCI, 2008)

• The “who” of professional development

• The “what” of professional

development

• The “how” of professional development

Bright from the Start: Georgia Department of Early Care and Learning

Inclusion Coordinators

Infant-Toddler Specialists

Marcus Coaching

From Theory to Reality

MAC Community Early Childhood Childcare ChildrenInterventionists Specialists Specialists ~ 2 years

Qualities that Distinguish

What is present in classrooms with a high prevalence of emotional regulation, active engagement, and expanded learning ?

Teachers who are aware of each child’s level of emotional regulation and are willing and able to provide stabilizing supports needed for active engagement and learning.

Reflective Functioning – Peter Fonagy

What is Reflective Functioning?

The ability to recognize and understand one’s own mental states, such as emotions, intentions, and wishes, as well as those of others, through symbolism and abstract thought processes, and to consequently show an appropriate reaction to those metal states (Fonagy, 1999).

Reflective Functioning in Action

• The simplest and most important expression of reflective functioning can be seen in the sensibility of an attachment figure within affective communication. Blehar et al. (1977) describe four vital aspects of this sensibility in an interaction:

• Attention to an infant’s state of well-being. The attachment figure should keep the infant in view, and be mentally present, but refrain from fixation.

• The correct interpretation of the infant’s communication. This interpretation should reflect the infant’s needs from his or her point of view, and not be tainted by the attachment figure’s own emotional needs.

• The attachment figure’s reaction should be prompt. This enables the infant to make an association between their behavior and the attachment figure’s reaction. This association gives the infant an intense feeling of effectiveness, rather than a feeling of hopelessness.

• The reaction is appropriate and gives the infant what it needs. This correct, prompt and appropriate response to an infant’s affective communication is a definitive example of reflective ability.

Reflective Functioning in the Classroom

Teachers who are able to reflect upon each child’s level of emotional regulation can then internally reflect, plan, and communicate accordingly to provide stabilizing supports needed for active engagement and learning.


This reflective ability facilitates the achievement of 25 hours of active engagement needed by children at risk of an ASD to significantly develop their social communication skills.


Early Childhood Specialists who are able to reflect upon each teacher’s level of emotional regulation can then internally reflect, plan, and communicate accordingly to provide the most effective learning experience through their coaching.

Agenda Awareness

Classroom

Agenda as a Working Memory Model

Central Executive

Pho

Phonological Loop

- Baddeley, Alan D.; Hitch, Graham (1974).

- Baddeley, Alan D. (2000).

Episodic Buffer

Visual- Spatial

Sketch Pad

Agenda as a Working Memory Model

Agenda Executive

Goals Priorities

What is most

important in this

moment.

Agenda Awareness

Teacher AgendaMarcus Coach

Agenda Childhood

Specialist Agenda

Asst. Teacher Agenda

Awareness Refined

Awareness

Reflection

Meeting of the Minds

• Meeting a team member where they are• Emotionally• Intellectually• Emotional Regulation – Upon beginning a

session, at any given moment within a session.

• Meeting a child where they are:• Developmentally ( Cognitively, Emotionally)• Emotional Regulation- Can change from minute

to minute.

Beginning Coaching

• MUST begin with a period of engagement.• Process by which parties establish a helpful connection

and a working relationship (Motivational Interviewing*)• Without engagement, coaching cannot go forward. • Key concepts: comfort level, understand each others’

perspectives, collaboration

• Next, you must have a joint focus• Establishing goals together. • Key concepts: goals, working towards common focus,

clear sense of end game.

*Miller & Rollnick, 2013

Motivational Interviewing

Directing Guiding Following

Motivational interviewing falls under

guiding style. Good listening combined with expertise when needed. *Miller & Rollnick, 2013

Motivational Interviewing

Motivational interviewing is about discovering what is already in place, not

installing what is missing.

***You have what you need and together we will find it!***

*Miller & Rollnick, 2013

Learning Through Success

The first step in positive change is not starting from nothing, but rather starting from a place of familiarity. The teacher

must believe that they already have the tools, they simply need to utilize them

more or in different ways.

Collaborative Coaching Toolbox

• Supportive Modeling• Always tied to child behavior.

• Positive Reinforcement of the Teacher• Always tied to child behavior.

• Decoding of Child Behavior• “So after you finished the book, you told the class that its

time to go outside and everyone is at the door. I see Timmy is still standing next to the carpet. I wonder if he knows exactly what he needs to do next?”

Collaborative Coaching Toolbox

• Open- Ended Questions • How do you feel…What do you think…How do you think

they…Would you agree that…?

• Reflection on Child Behavior • What is a child telling us with their nonverbal and / or

verbal communication. • Teaching moment + Opening Ended Question-

• “Knowing that our 1.5 year-olds have a need to move around a lot, how do you think you could structure their morning routine to make sure they get that opportunity?”

Marcus Coaching Model

Interactive Learning

Guided PracticeSelf-Directed

Practice

Guided PracticeCoaching the Coach

Sharing

informatio

n

Supportive modeling

Practice

with coach

ing

Practice with guided reflect

ion

Guided Practice

• Process is loosely based on “technical coaching,” defined by Garmston in his 1987 paper.• Technical coaching focuses on “the learning and

transfer of new skills and strategies into the existing repertoires of teachers.”

• Also based on the four components of effective training that Joyce and Showers (1982) recommend including: presentation of theory, modeling, practice and feedback.

Guided Practice

• Sharing information• Providing focus for the day’s session.

• Supportive Modeling• Process by which desired behavior is modeled while

providing thorough explanation of purpose to promote generalization.

• Should be used when verbal recommendations are not understood.

Guided Practice

• Practice with coaching• ECP is interacting directly with parent/teacher and is actively

coaching. • ECP is coached by CI throughout most interactions with teacher.

• Practice with guided reflection• ECP will “check in” with CI periodically to maintain focus on desired

outcomes. • Moving towards ECP’s independence in coaching teacher. CI is only

needed for quick consultations. • Guided reflection will also occur in video review• Based on concepts of reflective practice

• Because it can be difficult to develop a critical perspective of our own behavior, it is more likely to lead to greater learning if reflection occurs in a collaborative and cooperative environment (Osterman & Kottkamp, 1993).

Self-Directed PracticeCoaching the Coach

Sharing

information

guided by ECP

Practice with telecoaching

Practice with guided reflect

ion

Practice with independent reflecti

on

Self-Directed Practice

In “Self-Directed Practice,” we are working towards “mastery,” defined by Dunst & Trivette (2009) as, “engag[ing] the learner in a process of assessing his or her experiences in the context of some conceptual or practical model or framework or some external set of standards or criteria.”


• Sharing information guided by ECP• ECP will be guiding conversation and focus of the

day’s telecoaching session.

• Practice with telecoaching• ECP will coach in the classroom with CI available via

web conference for consultation.


• Practice with guided reflection• Again, working towards ECP’s independence in coaching teacher.

CI is only needed for quick consultations.• During video review, CI and ECP will have equal input in

discussion.

• Practice with independent reflection• ECP will have improved in self-awareness skills needed to

determine effectiveness of their coaching in reaching end goals. • Will also include components of reflective practice• During video review, ECP will guide discussion (independent

reflection on coaching skills)

Independent ReflectionExperiential Learning Cycle

Concrete Experience

Observation and analysis

Abstract Re-

Conceptualization

Active experimentation

Osterman & Kottkamp, 1993

Independent Reflection

Goal: to coach early childhood professionals to generalize knowledge and engage in reflective practice.

Reflection

Using definition from Dunst & Trivette (2009), reflection is defined as “engag[ing] the learner in self-assessment of his or her acquisition of knowledge and skills as a basis for identifying ‘next steps’ in the learning process.”

Reflective Practice

• Defined by Osterman & Kottkamp (1993) as the “means by which practitioners can develop greater self-awareness about the nature and impact of their performance, and awareness that creates opportunities for professional growth and development.” • Similar to concepts of motivational interviewing.

• Aligned with experiential learning • Learning is most effective and most likely to lead to

changes in behavior when it begins with experience.

Thank you!Any Questions???

Contact the Presenters:Sally Fuhrmeister, M.S. CCC-SLP

[email protected] Ziegler, M.S., Dipl.- Psych.

[email protected] 55

mailto:[email protected]



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